Conjunctival Pigmentation in Stevens-Johnson Syndrome

Examination of the conjunctiva/sclera and surrounding structures is an important component of any physical exam. The articles by Dr. Fuentes-Paez et al. and by Dr. Sharma et al. provide critical information for a good exam of the eye and surrounding structures. Reading these two articles in conjunction with a basic text of ocular microanatomy will provide a great refresher course on this topic. More importantly, it will also provide an invaluable guide to understanding the dynamics of changes in color and texture of the conjunctiva and surrounding tissue. We report a 29-year-old white woman with conjunctival pigmentation after a Stevens-Johnson syndrome (SJS) episode triggered by sulfasalazine. The patient developed bilateral tarsal and forniceal conjunctiva and black pigmentation. Diagnostic biopsy showed stromal monocyte infiltration consistent with chronic phase SJS and conjunctival pigment of melanic origin that was not due to drug deposition. Treatment with topical steroids and unpreserved artificial tears resulted in improvement of clinical symptoms; however, pigmentation was unchanged after 2 years.